Dr. Nicole Farmer — The Mental Health Benefits of Cooking

>> Hi, this is Nicole.

>> Hi Dr. Farmer! It's Diego. Can you hear me okay?

>> Yes I can.

>> Okay, great. Thank you so much for joining me today. Um, it's unfortunate that we can't meet in person, but we all have to do our part. How are you doing in the midst of this unprecedented crisis right now?

>> I'm doing okay. I'm home with my husband and two children. Um, so it's definitely a balancing act doing telework and also homeschooling, trying to just make it through.

>> Yeah, no, I totally feel you. I've been trying to stay as busy as possible. Granted, it's not like I can do a lot in the size of my small studio apartment, but I have been cooking a lot. And I know you wrote a review about the psychosocial benefits of cooking interventions. In it you suggest that cooking seems to increase self-esteem and improved psychological well-being. Can you tell me more about what that means?

>> Sure. So in terms of psychological well-being, what we found through that review in the literature is that there is, albeit limited, there is really interesting and intriguing evidence that cooking can improve one's global sense of self, so like global self-esteem, and that can come through cooking confidence or it can come through and improve social relationships that they're having as a result of sharing food or engaging with people regarding recipes. And so we also found some studies that actually looked at quality of life for people that went through cooking interventions and their quality of life assessments improved as well as a study that actually measured anxiety and found that anxiety improved also.

>> Interesting. So these cooking interventions that you looked at, I understand that they're typically used for like therapeutic or like rehabilitative settings. What I read is that it helped with—well it decreased anxiety and agitation in burn victims and people suffering from dementia. Is that correct?

>> Yes, that's correct. Those were the studies that we found in the literature. We don't know how far that applies to other populations just because it has not been studied yet. But that's some of the work that we're hoping to do.

>> So in those studies that you looked at, how are people looking into this connection between cooking and stress relief?

>> So we didn't find any studies that did any physiological assessments with people while they were engaging in cooking. That would've been ideal—or using anything like ecological momentary assessments where you ask people kind of how they're feeling in the moment.

>> And how would that look like? Just, you know, in a general sense. How would you set something up to test this possibility?

>> Well, yeah. So, I can tell you about what we are at least planning on doing in our community setting first.

>> Yeah.

>> So in that we are going to still rely on self-reported information from patients, but we're really asking them to report from home. So kind of mirroring that ecological momentary assessment, asking you questions in the moment. And so we're going to ask questions about engagement in terms of if they felt challenged, if they felt creative in the moment. And so these are variables that we think actually may contribute to someone actually having a wellbeing benefit from cooking. So that's how we're looking at it in the community setting. We're in early stages of designing inpatient studies where we will actually utilize the rehabilitation kitchen in the Clinical Center and then we will there be able to actually videotape participants when we ask them questions and then use software to kind of predict and determine what their affect response actually was pre and post cooking.

>> Oh, interesting. So you said this was in a community setting. So this is some, like a situation where they would be cooking together and then they self-report their attitudes based on that.

>> So we will teach them—everyone, we will teach the same cooking skills and give them a standardized culinary education for six weeks. And then for three months we are going to have them report on a daily basis those, how are you feeling when you're cooking responses.

>> So they would be cooking at home?

>> Right, right. And so we want to get an idea of when people are at home, are we able to really capture that well-being that was found in the interventions that were done mostly in a therapeutic setting or do like the daily interruptions of children coming in the kitchen or the phone ringing or having to answer email, possibly interrupt or disrupt that potential.

>> You mentioned that it was a community setting, I guess, but this seems like it's kind of individual.

>> Oh, thank you for that clarification. Yes. So we're looking at individuals, but we're doing it in an outpatient setting. Sorry, when I say community, I meant outpatient.

>> Oh, okay. Got it. That sounds pretty cool; to get free cooking classes and then, you know, just having to...

>> [Laughter.]

>> It sounds like a really good thing for your wallet and your mind.

>> Yeah. We have a chef that will be delivering the cooking education to everyone. And then before we actually start the cooking classes, we are having the participants come up to the Clinical Center in which we're doing an objective kind of cooking skill assessment so that we see where people are starting off and then exposing them to the education. And then we're actually going to bring them back after the intervention to kind of see if we've had any change in skills that occur from the intervention too. So that's kind of looking at a separate question within this study. And that's, can we actually improve people's cooking skill level and then is there a connection between the skills that people either maintain or obtain in terms of their well-being responses with cooking at home.

>> So it's like the first of its kind, this study, right. Just because, I mean, you've seen the literature and done a whole review, so this must be kind of brand new to the field.

>> Yeah. Yes it's very brand new to the culinary education field. Cooking interventions themselves in terms of nutrition, have really taken off in the last 10 to 12 years. And we found from cooking interventions that there's been improvement in self-reported dietary outcomes in people reporting, cooking confidence improvements. But there is a gap in terms of understanding what is the behavior that's occurring as a result of that. Um, like people have not been measuring the actual cooking behavior. Um, and then we're adding the element of connecting cooking but psychosocial health in our study. So yes, it's very much the first of its kind.

>> Wow. I like the phrase cooking confidence. I like that a lot.

>> Oh good.

>> I think, I mean it ties into—on a personal note, I think it's very helpful, cooking that is, for lowering stress because it requires like your full attention. I mean you're dealing with like sharp knives and hot surfaces here so the kitchen isn't really isn't a place where you can like work on autopilot. Do you think that could help explain why cooking lowers stress? It's kind of like a meditation, if you will, where your mind is like kind of preoccupied with something else so it doesn't have time to wander and like think about all the other things that are going on in your life.

>> Yes, I do. So I think there's a, I would call it like a contemplative, type of practice is what you described where it's taking you away and allowing you to have focus and attention. And then there's also the executive planning that has to occur in cooking. I mean, even if we're making a simple grilled cheese sandwich, there are still steps and a process that we either wittingly or unwittingly kind of engage in, but our brain is processing and taking us through those steps. So that also allows for some—in terms of like working memory and procedural memory—it allows for emotional regulation to occur. So I think that that's also another way that we get benefit from cooking.

>> Right. So it seems like there's kind of a significant amount of work on this. Do we know what our brains kind of look like while they're cooking or...?

>> You just stated what I hope we will uncover in the next few studies we do after these initial ones. Um, but it has not been evaluated extensively. There are a couple of studies that have looked at master chefs in Italy that found that master chefs compared to your typical home cooks tend to have larger cerebella. And so that's not surprising given the amount of like dexterity that they have to have, but also potentially given the amount of executive function between like the cortico-cerebellar connections that they have to have to put forth every day, multiple times a day. Um, and in that same group in Italy also, um, took a patient that had a cerebellar stroke and although they didn't do any imaging studies, they subjected that patient to essentially a master chef type of therapy session where the patient had to cook every day for six weeks, seven to 14 dishes a day and the patient had significant improvement in executive function and cognitive function tests afterwards. So I think that those two studies, if we take them combined, give us some initial evidence that it probably is worth looking into what happens with our brain function when we are engaged in cooking.

>> That's crazy.

>> Yeah, it is. It's very interesting. I mean, I think this whole notion of cooking is something that we all either choose to do or choose not to do every day. We have like a conscious or unconscious connection to it. Um, and we sometimes take it for granted, but it actually is an extremely important behavior for humans. I mean, there are anthropologists at Harvard who think that it is what makes us uniquely human from our gut physiology to our prefrontal cortex size to our social connections. And so that unique aspect of cooking, I think we are still hard programmed or hardwired to get advantage from. And it's not that, you know, because it becomes a little bit harder to do because of the daily life that we're not going to still have an advantage or a benefit from doing something that is so unique to humans.

>> Right. And they say that, you know, there was a huge leap between like Neanderthals and homo sapiens, right? The whole advent of like fire and cooking and that obviously is tied into like our biology.

>> Right? And so there was a science article that came out early this year in January that looked at what we now think is the earliest signs of cooking occurring in early humans. And interestingly, what they found from their dig sites is that there's evidence that people were sharing food. So it wasn't just that you got the food and you cooked it there and then just you or whoever you were with actually consumed it. But there is evidence that sharing occurred. So I mean, I think that that just all the more connects to the work that we're looking at, in terms of showing that yes, there is an actual like evolutionary basis for this benefit.

>> Right, right. The other thing that you kind of, already touched on this, but it's interesting to think that cooking isn't a stress antidote for everyone as much as it is kind of ingrained in our biology. So for people who, you know, are like culinary averse, do you have any advice for them?

>> One step at a time. I had a lot of patients who were culinary adverse. And so it really was, you know, if you're making a fruit salad, you're making a fruit salad and that same creativity and the same thought process and problem solving and executive function that somebody else may put into an extravagant Beef Wellington you're putting into your food salad. And so, you know, count everything that you do, in terms of preparing food together for consumption, as cooking. That was the advice I gave people. So they would start to feel a level of confidence and not being overwhelmed.

>> Yeah, baby steps for sure. And what about like cooking with others for those, you know, who are not necessarily like master chefs? Um, there's also benefits like you mentioned of like cooking together and obviously it's not the best time to be doing that with the whole social distancing that we have to practice. But, um, there is research that, like you mentioned that it has positive effects on socialization and like self-esteem.

>> Yes. Yes, indeed. So outside of the current environment, um, definitely when we can find ways to prevent social isolation—so behaviors that prevent that—we want to promote and encourage that. And it looks like cooking definitely is one. However, I want to say that that has not been formally studied as we kind of contrive social networks when we put people into cooking interventions and cooking groups. So we like kind of create this very nice social network where everyone wants to talk about cooking, but that larger question should really be addressed kind of at a population level or a community-evidence level, but that just hasn't been done yet.

>> Gotcha. That makes sense.

>> But from the interventions, we do suspect an improve socialization, um, and we know that it also increases meals together. That has been shown through several different studies and reviews.

>> Right. Um, well I saw that you also focus a lot on the cellular biology of diet and how it relates to cardiovascular disease. So then how do the psychosocial benefits that we've been talking about fit into that picture?

>> It seems tangential on the surface, but, um, it's actually very much connected. So the group at Harvard that I mentioned that is responsible for—I didn't say it before, but for the cooking hypothesis, which is that cooking is unique to humans—they've also done some really great work looking at the fact that the microbiome actually benefits from exposure to cooked food. And so their thought is that we, at the same time our brains were evolving into homosapiens, our microbiome was also kind of evolving to cooked food too. And so exposure to cook food improves microbial diversity. Um, and so the research that I'm doing on microbiome diet-related metabolites is centered one TMAO, which is a metabolite that is a biomarker for cardiovascular risk, but also on its own has a role in turning on inflammatory signals within endothelial cells. And so that particular metabolite, we get mostly through a very westernized animal food diet, similar to the diet of the patients that I had in my primary care clinic, but also similar to patients in food deserts—processed meats, red meat-heavy, eggs also. And so what we're finding is that the best way to actually help to kind of lower that TMAO exposure is through vegetables, exposure to vegetables, exposure to polyphenol rich foods.

>> And what are polyphenols?

>> Oh, so polyphenols are like flavonoids. They are plant chemicals that are found in vegetables and fruits that for us give us decreased inflammation and our cardiovascular protective.

>> Oh, okay. And that's found in most vegetables? That's something that's like in broccoli and spinach and all that stuff.

>> Yes, yes. Um, and so the epidemiological evidence, some of which our group has contributed to, it shows that cooking is the best dietary behavior to promote actually increased vegetable intake and exposure to polyphenol rich foods. Um, so that's kind of the connection between the two.

>> Well, it seems like you're covering the gamut of cooking. Um, how did all of this bring you to the NIH?

>> Yeah. How I got to the NIH was actually through cooking groups that I did with patients. I say that my journey to NIH is a bit of like reverse translational science. I was in primary care and addressing typical primary care problems, mostly cardiovascular disease prevention, and what I found is that when I would talk to patients about the Mediterranean diet and the DASH diet—diets that have very good sound evidence basis for preventing cardiovascular disease—they would look at me like, "I have no idea how to make that happen, I have no idea how to shop for those foods, I have no idea if my family will like it." And so my recommendations, became kind of like empty recommendations, almost like empty scripts that no one filled.

>> Yeah.

>> So, um, I decided to start teaching cooking classes after hours, in which we focused on the Mediterranean and DASH, solely just to introduce people to this is how you can implement this and put this into operation in your home. From that kind of very pragmatic type of exercise with patients, I started to notice that people who I knew who were very socially isolated and very insecure with themselves, from following them for many years, were like coming out of their shell and telling me about all these wonderful things they were engaging in. And I'm like, oh, that's very interesting. And they're the ones who told me, "I think it's because of cooking." And so that is what led me to start to look in the literature for connections with cooking and psychosocial health. And that primary care practice where I worked was in a suburban food desert. So I was dealing with food access issues when I was also talking to patients. We had very limited supermarket availability and a lot of patients that I had did not have a lot of discretionary income in order to have elaborate dinners from Mediterranean or the DASH diet. So from that practice I became very aware, um, of social determinants of health and how they actually can affect diet quality. That's why another aspect of my research is that. In that community study that I talked about, we're actually doing that in a food desert in ward seven and eight in Washington, D.C. You know, you kind of go where the disease potentially can be worse. So we want to see like people that probably have very limited food skills or at least the ability to exercise food skills. Like what is the impact that we can have on well-being and what's the impact we can have on cooking behavior in that community.

>> Mm. Right. And you said access to like fresh food; you mentioned the Mediterranean diet, I'm not too familiar with what that means. What is like the basis of that?

>> Yeah, so the basis of the Mediterranean diet comes from a clinical trial, the predimed study, that looked at the role of mono- and saturated fats through olive oil and nuts and then increased in amount of seafood and fruits and vegetables, the impact that has on cardiovascular risk in a population. Um, and so that study was not done in the US, obviously, and those participants were provided with olive oil to help them adhere to the intervention diet. But we do know that kind of translations or adaptations of the Mediterranean diet done by Americans includes an increase in the amount of fruits and vegetables and seafood. And therefore just by that we term it as cardiovascular healthy or lowering cardiovascular risk.

>> Gotcha. That makes sense.

>> What I also uncovered in the literature when I was still in practice was that African Americans tend to report less home cooking frequency than other racial and ethnic groups. Just by food access statistics, most African American neighborhoods actually don't have a fresh food supermarket located in them or they have just one. That opened up my eyes to another reason to kind of go into this research that was related to social determinants in health disparities.

>> Great. Okay. So just one last cooking related question and this one might not...

>> Oh, I could talk about cooking all day.

>> Great. Well this one might not be in the literature, but does cooking certain things relieve more stress than others? Say like baking a pie versus like grilling some ribs.

>> It is like you are really diving into my future studies list. Um, so that I'm also interested in learning, because there is obviously a multisensory experience that happens when we cook. We have like the smells and also the sounds that are occurring. And so what role that may play in people actually having a well-being experience with cooking, I don't know, but I really do think that working at the NIH is the right place for us to help try to find out.

>> Perfect. Well, what's your favorite thing to cook, just out of curiosity?

>> Risotto.

>> Risotto, okay. I don't think I've tried my hand at that, but I have plenty of time now.

>> Right. You do. You do. It has a lot of variability. You can add pretty much anything to it at the end. And it's yummy and a great comfort food.

>> Right. Awesome. Well, thank you so much for all this food for thought, Dr. Farmer.

>> No problem. Thank you so much, Diego.